Is Bariatric Surgery Right for You?

With Anita Courcoulas, MD, and J. Michael Gonzalez-Campoy, MD, PhD

Maybe you are contemplating bariatric surgery or your doctor has mentioned that you might benefit from a gastric bypass procedure. Naturally, you may be wondering: How will I do? What success can I expect to I have?

Being able to predict which patients with obesity may have the best outcomes has been an elusive goal, until now. A team of researchers is reporting that success hinges, at least in part, on the subtype or characteristics in each patient;1 their study appears in the journal, Obesity.

Patients want to know if they will do well after gastric bypass surgery. Doctors now have some guidance about which obese patients might lose the most weight after bariatric surgery, according to University of Pittsburgh researchers.

Before Bariatric Surgery, Can Patient's Success Be Predicted 

As more patients consider having bariatric surgery, researchers have noticed that many patients achieve greater weight loss with the procedure known as Roux-en-Y gastric bypass than gastric banding, but even among patients undergoing the same type of procedure, there have been different patterns of weight change.2

So the Pittsburgh research team looked at participants who were already enrolled in a long-running study to tease out what experts are beginning to call obesity subtypes.

To arrive at the four subtypes, the researchers considered not only the individuals’ body mass index (BMI) and a diabetes diagnosis but also factored in the participants' eating behaviors, appetite, physical activity, family history of obesity, glucose metabolism, heart health. and other measures, according to the senior author, Anita P. Courcoulas, MD, chief of the section of minimally invasive bariatric and general surgery at the University of Pittsburgh School of Medicine.

A Closer Look at Characteristics of Obesity

The participants had bariatric surgery at one of 10 hospitals across the country. They underwent follow-up physical exams at one month, six months, one year, and then annually for up to seven years.1

The researchers gathered information on these patients’ appetite, eating habits, food patterns, family history of obesity, glucose parameters and diabetes status, cardiometabolic and overall health, in addition to weight loss after surgery.1

The researchers assessed participants for a predetermined set of characteristics and then categorized the 2,456 adults—all of whom had obesity as their common metabolic feature—in the Longitudinal Assessment of Bariatric Surgery (LABS) study into one of four subtypes:  

Group 1: Patients (91) had type 2 diabetes (T2D) and a low level of so-called “good” cholesterol (ie, high-density lipoprotein [HDL]).

Group 2: Individuals with disordered eating reported binge eating or similar irregular eating behaviors. More than one-third (36%) of participants fell into this subtype, with 892 participants reflecting this characteristic.

Group 3: Mixed, meaning individuals did not demonstrate a single. clear characteristic, rather a combination of features such as diabetes and early-onset obesity were more commonly identified. About half of the patients (1,108) were classified to this subtype.  

Group 4: Anyone who experienced early onset obesity that was defined as extreme obesity with a body mass index (BMI) of 40 or greater. There were 365 meeting these criteria.

Matching Weight Loss Against Types of Obesity 

After following most of the participants for up to seven years, the researchers found that those with disordered eating responded somewhat better at the three-year mark in terms of weight loss.1

"Individuals with disordered eating lost more weight overall in comparison to people in the three other groups, with men losing an average of 28.5% and women 33.3%, respectively, based on their presurgery weight," Dr. Courcoulas tells EndocrineWeb.

"Patients with disordered eating behaviors benefited more from bariatric surgery than patients with diabetes and/or patients with early onset of extreme obesity," she says. Disordered eating refers to a range of irregular eating patterns but most common was a pattern of binge eating.

When asked why she thought the people with disordered eating were most successful at reducing their body weight, she says, "I would hypothesize that this may be due to the fact that the surgery helps these patients limit their portions, reduced their appetite, as well as some other contributing factors that may exist."

In contrast, those in class 4—people with early onset extreme obesity—lost 25% (men) and 30% (women) of their starting weight, which is pretty close to the same amount as those in class 1—with diabetes and low HDL. Those in class 3, the group with a mixed obesity subtype, lost 28% (men) and nearly 32% (women) of their initial weight.1

"In the end, it appears that patients with disordered eating behaviors benefited from bariatric surgery more than patients with diabetes and/or patients with early onset extreme obesity," she says. Yet, the procedure seemed helpful for everyone who had the procedure.1

Benefits of Gastric Bypass Surgery Remain High for All

The study lends some insight into caring for those with obesity or overweight, says J. Michael Gonzalez-Campoy, MD, PhD, FACE, medical director and CEO of the Minnesota Center for Obesity, Metabolism, and Endocrinology. He was not involved in the study but reviewed the findings for EndocrineWeb.

The new study not only helps predict who may do better in keeping off the weight after bariatric surgery, he says, but also points out the chronic nature of obesity. Because the researchers found out information about eating habits, family history of obesity and other contributing factors, which play a role in weight maintenance, the findings also point to the importance of addressing other issues that may affect the success of the surgery, he says.

Whichever category a person falls into, one thing is the same, "All of these patients have a life-long disease, so ongoing long-term pharmacotherapy (ie, weight management medications) to support weight loss and maintenance is likely appropriate,” Dr. Gonzalez-Campoy tells EndocrineWeb. “And monitoring for complications of obesity such as nutrient malabsorption as a result of the surgery is a concern that requires lifelong follow-up."

A Bit of Background on Disordered Eating with Obesity

The term disordered eating is used to describe a range of eating behaviors that are considered irregular, or out of the norm; these actions may or may not warrant a diagnosis of a specific eating disorder, depending upon the development of medical complications,3 according to nutrition experts.

Among the most common symptoms of disordered eating are:

  • frequent dieting (low calorie intake)
  • anxiety associated with certain foods or food groups
  • significant weight fluctuations  

Individuals who experience any form of disordered eating may have rigid rituals and routines around food and exercise; some may secretly binge and then feel guilty about eating. Another sign of disorder eating is viewing exercise or fasting as a way to make up for having eaten “badly.” Still, others binge out of stress or to relieve emotional feelings that cause painful thoughts.

When someone develops a pattern of disordered eating, especially characteristic out of control eating or binging on high calorie or calorie dense foods, it may lead to sustained weight gain, requiring medical intervention, such as bariatric surgery.

 

Dr. Courcoulas reports research grants from Covidien and Ethicon J&J Healthcare. Dr. Gonzalez-Campoy has no disclosures.  

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